Minimising women's feelings re: smear tests

[Gisla]

On local radio this morning they were talking about the importance of smear tests, due to rising numbers of women dying from cervical cancer.

However as part of the discussion they featured a cancer survivor who said the smears were important (fine) and that women should just "close their eyes until it's over".

I understand that the speaker was talking about something very important to them and it's obviously a very important issue, but it struck me that the language used was not very sympathetic to the very valid feelings and emotions that can be involved with such an intimate exam.

Besides the obvious 'lie back and think of England' connoctation, it also reminded me of the way women have often been treated during pregnancy or birth, and the idea that we just have to put up with invasive treatments and get over it. Silly women that we are.

Queen - I'm glad you don't find it traumatic. I don't either - either neutral or mildly uncomfortable depending on how skilledthe HCP doing the smear is (and how good a bedside manner they have).

But the points being made on this thread are threefold:

1. some women do find it traumatic, and it is up to them to decide whether the (small) risk outweighs their trauma or not. Their bodies, their choice.

2. when you look at the actual hit rate/false alarm rate and the cost benefit ratio (low risk of death, much higher risk of cervical incompetence following unecessary treatment) it is by no means clear cut that the screening programme actually does more good than harm. You might think that 1 life saved is worth (I don't know the precise figures) 10, 20 otherwise healthy women being unable to carry a pregnancy to term, but the women left unable to carry a pregnancy to term might disagree with you. As with all healthcare decisions involving balancing mortality/morbidity and length of life versus quality of life, it's a very very difficult choice - and again, one which women should be allowed to make their own choice on.

3. no-one takes the HPCs who are crap at it to task for being crap! The onus is entirely on the women on the receiving end to "woman up". This needs to change.

It's not 'the only way'.

Diy smear tests are being developed.

That's the way forward for women who don't want ones done by doctors/nurses.

Not bullying women.

My body, my choice.

I consider myself to be a feminist AND have encouraged other women to have smear tests - I don't see that the two are in opposition

I completely agree with Finally here. I was petrified of smear tests after an intimate injury as a child, I still don't find them easy, I've had to have colposcopy twice but there's no way I wouldn't go. Ever.

I really, really feel for anyone who suffers anxiety around smear tests. I have generalised anxiety disorder myself. But if I was so frightened, I'd look into hypnotherapy or even speak to my doctor about being prescribed half a diazepam before I went in. If it was my wee sister saying she wasn't going to go for her smear, I'd be really frightened. It's not about lying back and thinking of England (Scotland in my case, where we get tested from age 20), it's about thinking of yourself. Which is a feminist act, IMO. I wish to God there was a less invasive way of testing but until there is I'll put up with something horrible if it'll help me not get cancer.

What a relief, after a hysterectomy, not to have smear tests again.

Lurcio the last if your points isn't specific to smears though. When I was pregnant and having blood tests I always crossed my fingers about which phlebotomist I'd get. One was fine. The other seemed to think I was a pin cushion.

Sorry I meant to also say; And I would never have said anything to her

See my point 2 above - it is possible to make an informed, risk-based decision that you feel that the evidence is such that the benefits from taking part in the screening programme are not outweighed by the risks.

For instance, I take HRT. This increases my risk of getting certain cancers. I do it because I can't stand the insomnia and hot flushes which leave me like a zombie. Sure, no-one ever died of menopausal insomnia and hot flushes, but for me the impact on my quality of life is so great that I will make an informed decision to take a very marginally increased rate of contracting cancer - even though there is an outside chance that cancer might kill me. I don't do this out of some wilful head-in-the-sand attitude, or because I'm thick, or because I'm ill informed, or because I don't understand statistics (in fact, if you want a lecture on false alarm versus hit rates, ROC curves for assessing probabilistic tests like epidemiological assessments of screening programmes, error bars and the like then I'm you're woman - it's part of my day job, albeit in physical rather than medical sciences).

And if some other woman applies the same reasoning to smear tests - that for her the trauma associated with them, given that they have a high rate of false positives and unnecessary treatment, treatment which can have serious side effects, means that she would rather run the small risk of contracting cervical cancer and having it treated late - that's her choice to make.

YesYes.

When I was pregnant, I shocked the consultant first by questioning why she was prescribing me aspirin, and then saying that I wasn't going to take it (she still put it on the prescription!) because I'd read about the reasons, and didn't feel that the benefits outweighed the risks in my particular circumstances.

I think that unlike men/prostate checks, there 's a definite expectation that women/smears/whatever else are a given, that why would we not do it because it's for our own good.

Men are just assumed to not want to do it/need logical persuasion, and women are assumed to do as they're told/do it because "it's in your best interests"

I'm not frightened of smear tests. They don't hurt me, and I don't have any sort of trauma surrounding them. I don't suffer from anxiety about them and I go for regular std tests (around once a year) which often involve similar procedures. I have, however, made an informed choice not to have smear tests. Being told to shut my eyes until it's over is infantilising. I'm certainly not ever going to take Valium just to get through one.

By all means have them yourself. Even 'encourage' other women to do the same. But if a woman turns round and says "I've decided I don't want to" then you do have to accept that it is her choice, and it may well not be your place to try to persuade her otherwise. Because, as a fully grown adult, she gets to make her own medical decisions. And no woman should have to explain to anyone why she doesn't want an invasive procedure.

I recently had a colonoscopy and it was treated with much more sensitivity than any (of the many) vaginal examinations I had.

I remember my first smear. I was 18 (20+ years ago). The clinic was surprised that I was going home by myself, which baffled me before the smear was done- I was more than capable to get myself around.
But afterwards I was in mild shock. I clearly remember walking home feeling shaken and wobbly. I felt violated in a way I wasn't used to.
2 children later and I'm very used to HCP looking and probing me in that department.
So I was shocked at the song and dance made about the colonoscopy. Sedation is given as standard but I refused it because I needed to drive later that day. It was painful and intrusive but less than what you go through during vaginal exams. I have been unlucky and had more swabs, sweeps and coils fitted than most but I've never been offered any kind of sedation or pain relief. Actually, once they got a nurse to come in to hold my hand during a particularly painful swab. That's the only pain relief I've been offered.

I'm pretty sure that the colonoscopy was treated more sensitively than vaginal exams because men have bottoms too.

Yes, no doubt that's it and the medical profession are just a bunch of women haters who couldn't give a rats ar*e about us ! But when it comes to an invasive procedure on a man, they bend over backwards to make it as painless as possible. Do you actually believe that !?

Another thought - there are any number of choices an individual can exercise over their body, some of them we do not allow because of the greater harm it is perceived to have on society, e.g. heroin use. If the NHS can save money by detecting cancers earlier, then I for one am of the opinion that they ought to do that an encourage women to do the same. Choices are not made in a vacuum.

I think they need to find better ways of helping some women overcome their fear. I was always terrified but managed to keep it together just enough to get through the test. Quite an acheivement for someone with ASD. The midwife who examined me after DS's birth traumatised me by carrying on despite me telling her repeatedly to stop. Since then I can't keep a lid on it. I've been tipped over the edge from barely controlled terror to complete hysterical breakdown. I keep making appointments because I want to get it done but then the fear starts to build.

When I go to dentist I get sedated. I wish I could get the same for a smear. I'm terrified of the consequences of not having it done and of having it done :(

I can't help but wonder if I've just been really, really lucky with the nurses who've done my smears. They've always been great - done their best to relax me, offered to let me come back another day if I was finding it too hard (as I say upthread, I have an anxiety disorder). I've never felt that I was being treated with anything but respect and kindness, they'd suggest before I even lay down what might be the most comfortable way to do it. The nurse at my local GP actually added an extra appointment to her schedule so my DSis could get her smear done after work, not before. I'm in the West of Scotland and, though nobody I know enjoys smears (obviously), none of my friends have ever reported experiences like the ones I'm reading here. Different practices for different NHS regions, maybe?

I booked my first one an hour ago.
I'm bricking it

Pat, for most people it is only mildly uncomfortable, you've just got to keep your internal muscles relaxed, which is not easy when you are feeling nervous about it. Let your nurse know it's your first one and you're worried, and he or she (almost certainly a she - you can request a female nurse if you need to) will do their best to reassure you.

itllallbefine, cervical screening (indeed many screening programmes) is not quite as straight forward because it may result in people having treatment for abnormalities that would actually correct themselves over time anyway. (A smear doesn't detect cancer, it detects abnormal cell changes). As discussed in the Woman's Hour programme I linked to above, HPV primary screening will be much more targeted and also save a good wedge of cash. I agree that we should all be encouraged to participate positively in our health and wellbeing (as evidenced by the warm response to the recent changes in alcohol guidelines ) but screening programmes deal in generalities. People need to make informed decisions.

I should say for balance I have never had a bad smear except the one I had with a terrible champagne hangover, which I think we can safely conclude was not the fault of the NHS And even that one was not painful, I just felt rougher than a badger's arse. I have never had any exam done that wasn't conducted sensitively - that should be everyone's experience.

I've always been pretty blasé about smears - had first one at 17 and a fair few since. Until December when the nurse caused me such intense pain, didn't listen to me, and I walked out pretty much feeling shellshocked and was in pain for 3 days, and then had a letter to say she hadn't even got enough bloody cells! A lot of tears were shed and there is no way on earth I would go back to that surgery for one again (I've since had a completely painless one from my very lovely gynaecologist).

I've been having smears every 3 years for c. 20 years and they are the sort of thing I just try and 'get on with'.

I've only had one 'problem' smear - and the nurse carrying it out made me feel like it was ME who has something wrong for finding it painful, not that she was crap at doing it! So yes, in that respect I agree that it shouldn't always be down to the woman to 'just get on with it'.

I would love a DIY smear test!

I always found them unpleasant (really unpleasant) but dutifully attended. Then, a few weeks after childbirth, I had one so excruciatingly painful and awful that I haven't been able to have another since. (This was 10 years ago.) I know I should, I just cannot bring myself to do it - I feel traumatised at the thought.

I don't know why my reaction is so strong but there seems to be no help with this other than 'get on with it'.

I have major issues with smears. And in my experience none of the medical professionals who've done them on me have suggested I should just close my eyes and get on with it. They're always very understanding. So why do I need to be told to do that by other women?

I personally always go, but do sometimes take months to pluck up the courage to book the actual appointment after the reminder comes through. If I hadn't gone to my last one I would have regretted it because they found bad cells. But that's my choice and I do it on my terms in my own time. If someone tells me to "suck it up" or similar on this or anything else I tend to go a bit postal to be honest,,..

I agree, OP, that the language you heard in that interview wasn't appropriate.

But I can also understand that anyone who has had cervical cancer or lost a relative to it might feel very strongly about it and perhaps the use of sensitive language then goes out the window.

On the actual topic of smear tests, though, I dont think anyone who doesn't have them for whatever reason 'should just lie back and do it'...I think they should try to tackle the reasons they don't like having them - whether tuts pain, fear of pain, embarrassment, issues around sexual abuse or trauma etc - and ask for support with them - because one thing is for sure, smear tests can be lifesavers.

I lost a friend last year at 36 years old. She was admitted to hospital with a kidney infection (no other symptoms) and found to have stage 4 cancer - terminal. She died 8 months later. She had never had a smear test, and the doctors did say categorically that if it had been picked up at an early stage, it would very likely have been curable. She left behind three children. Whatever the discomfort of a smear test might be, it is not worth that.

So, no, women shouldn't just 'shut up and put up', but as responsible adults (especially as parents) they should seek advice and support to overcome any barriers they might face to accessing this type of preventative healthcare.

I've had one smear test in my life. It was awful. The nurse said 'it's always harder getting a sample from a fat person' I lay there and cried til it was over and never went back

I was terrified before my first smear (was 20, a student having a mental breakdown). Luckily my GP was a wonderful woman who had gained my trust and suggested giving me two doses of temazepam (one for before, one for after - thanks to getting free prescriptions) and doing the smear herself. She then managed to distract me during the whole procedure pretty well - I recall being advised to lie on my side and think of my favourite fantasies - "sexual fantasies are ideal, but for god's sake don't tell me about it!" Went home and had the second jelly and read a nice book.
So when I needed my next smear I mentioned this to the GP who looked faintly alarmed and said I'd be much better off with Nurse X who was really good at smears apparently. And suggested I might not want nurse Y in the circs. Nurse X was fine - Nurse Y happens to be a competent nurse and did later do smears, but doesn't come across as "friendly".

I'm sure that without that care, time, and support then, I'd never have managed a smear and might well have had even worse mental health over the next decades, but in fact managed to hold down careers and be mostly OK (until needing similar support when pregnant).

I think people think it's much less risky missing out on preventative medicine (smears, vaccines) than responsive medicine, which most blood tests are. Certainly vaccines are followed up in a similar way, and I know plenty of people who don't get flu jabs mainly because they are scared of injections. We need all medical practioners to understand fear and that the best way to get people through it when necessary is rarely to dismiss it nor tell people they are being silly - but as most parents do that to their children regularly, its probably not going toimprove fast.

From reading this thread it seems the problem isn't smear tests themselves, but what surrounds them, previous trauma, disrespectful language, coercion, awful practitioners.

I've had Grade 3 and the appropriate treatment. It was pure chance that I had agreed to a smear on that occasion, I had been dodging them for about 12 years. I'm grateful to be honest that my GP mentioned it when I was in about my sore throat. Wouldn't have liked to leave it another 12 yrs.

I'm interested in Hopingforbetter's post. I've never heard of the suggestion that one needs to be accompanied home after a smear test.Maybe the practice is different outwith the UK as you wouldn't be offered one at 18 here. It was an unhelpful and disquieting remark to have made. If you hadn't been worried before it would certainly make you worried.

I don't honestly think the reason pain relief is offered for a colonoscopy is just because it affects men.